A
American Speech-Language-Hearing
Association Functional Assessment
of Communication Skills for Adults
Diane Paul
Clinical Issues in Speech-Language Pathology,
American Speech-Language-Hearing
Association, Rockville, MD, USA
Synonyms
ASHA FACS
Description
The American Speech-Language-Hearing Asso-
ciation Functional Assessment of Communication
Skills for Adults (ASHA FACS) was designed as a
quick and easily administered measure of func-
tional communication behaviors at the level of
disability in adults with speech, language, and
cognitive-communication impairments (Frattali
et al. 1995; Frattali et al. 2017). The ASHA
FACS uses the following definition of functional
communication: “the ability to receive or to con-
vey a message, regardless of the mode, to com-
municate effectively and independently in a given
[natural] environment” (ASHA 1990, p. 2). The
World Health Organization (WHO 2001)
# Springer International Publishing AG 2017
J. Kreutzer et al. (eds.), Encyclopedia of Clinical Neuropsychology,
DOI 10.1007/978-3-319-56782-2_854-4
International Classification of Functioning, Dis-
ability and Health (ICF) provides the framework
for functional assessment. The ICF consists of two
components: functioning and disability (body
functions/structures and activity/participation)
and contextual factors (environmental and per-
sonal). The ASHA FACS assesses communica-
tion in the context of daily life activities. The
ASHA FACS is based on direct observations by
speech-language pathologists or significant others
who are familiar with the client’s typical commu-
nication performance across four assessment
domains: social communication; communication
of basic needs; reading, writing, and number con-
cepts; and daily planning. Within each domain,
specific functional behaviors are rated on a seven-
point Scale of Communication Independence,
which ranges from “does” the activity indepen-
dently, through five levels of “does with” varying
degrees of assistance, to “does not” perform the
activity. A second scoring system, the Scale of
Qualitative Dimensions of Communication, uses
a five-point scale to rate adequacy, appropriate-
ness, promptness, and communication sharing.
Assessment Domains
Table 1 shows the behaviors that are included
within the four assessment domains. The measure
yields domain and dimension mean scores, over-
all scores, and profiles of both communication
independence and qualitative dimensions.
2 American Speech-Language-Hearing Association Functional Assessment

American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults,

Table 1 ASHA FACS conceptual framework
Qualitative dimensions
Adequacy Appropriateness Promptness Communication sharing
Definitions
Frequency with which Frequency with which client’s Frequency with which Extent to which a client’s
client understands gist of communication is relevant and client responds without communication poses a
message and gets point done under the right delay and in an efficient burden to the
across circumstances manner communication partner
Assessment domains
Social communication Communication of basic Readings/writing/ Daily planning
needs number concepts
Behaviors
Uses names of familiar Recognizes familiar faces/ Understands simple Tells time
people voices signs Dials telephone numbers
Expresses agreement/ Makes strong likes/dislikes Uses references Keeps scheduled
disagreement known materials appointments
Explains how to do Expresses feelings Follows written Uses a calendar
something Requests help directions Follows a map
Requests information Makes needs/wants known Understands printed
Exchanges information Responds in an emergency material
on the telephone Prints/writes/types name
Answers yes/no Completes forms
questions Writes messages
Follows directions Understands signs with
Understands facial numbers
expressions/tone of Makes money
voice transactions
Understands nonliteral Understands units of
meaning and intent measurement
Understands
conversations in noisy
surroundings
Understands TV/radio
Participates in
conversations
Recognizes/corrects
communication errors

The ASHA FACS includes: Historical Background

A revised manual (Frattali et al. 2017) detailing
the project rationale, review of functional com-
munication measures, description and valida-
tion data, and administration and scoring
procedures
A score summary and profile forms
A case example
A pull-out rating key with the Scale of Commu-
nication Independence and the Scale of Quali-
tative Dimensions of Communication
The ASHA FACS evolved from the wave of
healthcare accountability and the widespread
need for an effective instrument to measure the
functional communication of adults who have
speech, language, or cognitive impairments for
purposes of justifying payment, defining service
eligibility, and judging the value of care. Devel-
oped in 1995 by ASHA, it reflects the collabora-
tive effort of more than 70 individuals, both
ASHA members and related professionals. The
ASHA FACS was supported in part by the U.S.
American Speech-Language-Hearing Association Functional Assessment
Department of Education/National Institute on
Disability and Rehabilitation Research (NIDRR)
and the U.S. Department of Veterans Affairs. The
Psychological Corporation provided expert
advice and data analysis.
The ASHA FACS originally was validated on
adults with aphasia following left hemisphere
stroke and adults with traumatic brain injury
(TBI). The original validation study was
conducted primarily with African American and
White adults with these communication impair-
ments. ASHA conducted further validation testing
from 1998 to 2003 with other racial/ethnic groups
and patient populations and created an addendum
to the ASHA FACS (Paul et al. 2004a). The
research was supported in part by NIDRR. A
revised manual includes the validation data from
the addendum (Frattali et al. 2017).
Psychometric Data
The usability, sensitivity, reliability, and validity
of the ASHA FACS were demonstrated through
two separate pilot tests and one field test. The first
version was piloted to determine the measure’s
usability, resulting in the development of a
seven-point observational rating scale. A second
pilot test confirmed the usability of the revised
version, and acceptable levels of reliability and
validity were found. A more sensitive scoring
system for capturing qualitative information
about the nature of a client’s functional commu-
nication led to the addition of a second scoring
feature, a five-point rating scale of qualitative
dimensions.
To establish interrater reliability during the
field test, the ASHA FACS was completed inde-
pendently for 35 subjects by two examiners within
a 48-h period after a minimum of three subject-
examiner contacts. Interrater reliability correla-
tions on the four assessment domain scores ranged
from 0.88 to 0.92. Overall communication inde-
pendence scores had high interrater agreement
(mean correlation = 0.95). Interrater consisten-
cies of the four qualitative dimension mean scores
ranged from 0.72 to 0.84. The interrater reliability
of overall qualitative dimension mean scores was
3
0.88. Intrarater reliability (38 subjects) for com-
munication independence mean scores by assess-
ment domain ranged from 0.95 to 0.99 and
intrarater reliability of overall communication
independence scores was 0.99. Intrarater reliabil-
ity of qualitative dimension mean scores ranged
from 0.94 to 0.99 and 0.99 for the overall quali-
tative dimension scores.
The ASHA FACS was moderately correlated
with other measures of language and cognitive
function as demonstrated by external criterion
measures used with subjects with aphasia and
cognitive-communication impairments from
TBI. For subjects with aphasia, a correlation of
0.73 was obtained between the Western Aphasia
Battery (WAB) Aphasia Quotient (AQ) (Kertesz
1982), and the ASHA FACS overall communica-
tion independence score. Correlations were
obtained between ASHA FACS domain scores
and WAB subtest scores, with a range of .038 to
0.81. Correlations between the ASHA FACS
domain score and overall score and each of the
Functional Independence Measure (FIM) scales
(FIM 4.0; SUNY at Buffalo Research Foundation
1993) ranged from 0.61 to 0.83. For the subjects
with aphasia, correlations also were computed
between ASHA FACS qualitative ratings and
external criterion measures, the WAB and the
FIM. These results indicated moderate correla-
tions. External validation data for the subjects
with cognitive-communication impairments
ranged from 0.66 to 0.78 between the Scales of
Cognitive Ability for Traumatic Brain Injury
(SCATBI) (Adamovich and Henderson 1992)
severity scores and the ASHA FACS domain
scores and a 0.78 correlation between the ASHA
FACS overall domain score with the SCATBI
severity scores. Correlations ranging from 0.72
to 0.86 were found between ASHA FACS overall
mean communication independence scores and
FIM scores for subjects with cognitive-communi-
cation impairments. Moderate correlations also
were found between ASHA FACS qualitative rat-
ings and the SCATBI and the FIM for this subject
group.
High internal consistency and social validity
were reported. Internal consistency indicated that
most item scores covered the full seven-point
4 American Speech-Language-Hearing Association Functional Assessment
communication independence rating scale,
showed high inter-item correlations between
items within assessment domains, were internally
consistent with respect to assessment domain, and
that all items were measuring the same underlying
construct. The data indicated that all domain
scores correlated with overall ASHA FACS
scores. Evaluation of social validity was accom-
plished by correlating overall ASHA FACS scores
with measures scored by family members or
friends of subjects. These measures included the
Communicative Effectiveness Index (CETI;
Lomas et al. 1989) and a rating of overall com-
munication effectiveness, a single overall index of
each subjects’ communication effectiveness rated
on a scale from 1 (lowest) to 7 (highest). These
data indicated high positive correlations between
ASHA FACS overall scores and ratings of overall
communication effectiveness by clinicians (i.e., r
= 0.81). The ASHA FACS overall scores did not
correlate well with family members’ or friends’
ratings of overall communication effectiveness or
CETI scores. CETI ratings were consistently
higher than those measured using the ASHA
FACS.
Clinical Uses
The ASHA FACS was designed for clinicians to
rate functional communication behaviors of adults
with speech, language, and cognitive-communi-
cation impairments resulting from left hemisphere
stroke and from TBI. In a review of the evidence
leading to recommended best practices for assess-
ment of individuals with cognitive-communica-
tion impairments after TBI, the ASHA FACS
was one of a few standardized, norm-referenced
tests that met most established criteria for validity
and reliability for use with this clinical population
(Turkstra et al. 2005). It was one of only four of
the 31 tests reviewed that evaluated performance
outside clinical settings. It was unique in that it
was based on research about daily communication
needs in the target population and incorporated
consumer feedback about ecological validity into
the design. The research is rich in the many clin-
ical benefits of the ASHA FACS. For example,
this instrument has been used to measure commu-
nication disability relative to quality of life in
adults with chronic aphasia (Ross and Wertz
2002; Davidson et al. 2003), to evaluate the effec-
tiveness of functionally based communication
therapy (Worrall and Yiu 2000), and to evaluate
real-life outcomes of aphasia interventions
(Kagan et al. 2008). Using Rasch analysis of the
ASHA FACS Social Communication Subtest
(SCS), Donovan et al. (2006) demonstrated that
caregivers were reliable respondents who could
use the SCS to rate therapy progress and func-
tional outcomes.
Additional research (Paul et al. 2004a) demon-
strated that the ASHA FACS is a reliable and valid
measure of functional communication for African
American, Hispanic, and White adults with cog-
nitive-communication impairments resulting from
right hemisphere stroke or dementia. Validity
could not be determined for Asian Americans
and Native Americans due to the small sample
size. Further research is needed to determine the
validity of the ASHA FACS for adults with
dysarthria.
ASHA established an international advisory
group to determine the validity, reliability, and
usability of the ASHA FACS in other English-
speaking countries (Australia, Canada, Ireland,
New Zealand, South Africa, England, and Scot-
land). Generally, the ASHA FACS was consid-
ered to be appropriate for use in these other
countries with adults with aphasia or TBI. Certain
test items were not relevant across groups, and
there were difficulties in administration in coun-
tries where multiple primary languages are used.
A Portuguese version was found to be valid and
reliable for adults with mild or moderate
Alzheimer’s disease (de Carvalho and Mansur
2008). There continues to be broad interest in
functional communication assessment for
populations with communication impairments.
The ASHA FACS should be used as part of a
comprehensive communication assessment, in
conjunction with measures of impairment and
quality of life. Treatment decisions should not be
made on the basis of a single instrument. The
ASHA Quality of Communication Life Scale
(QCL) may be used to assess the impact of
American Speech-Language-Hearing Association Functional Assessment
communication impairment on an adult’s partici-
pation in social, leisure, work, and education
activities (Paul et al. 2004b).
References
Adamovich, B., & Henderson, J. (1992). Scales of cogni-
tive ability for traumatic brain injury. Chicago:
Riverside.
American Speech-Language-Hearing Association. (1990).
Advisory report, functional communication measures
project. Rockville: Author.
de Carvalho, I. A. M., & Mansur, L. L. (2008). Validation
of ASHA FACS-functional assessment of communica-
tion skills for Alzheimer disease population. Alzheimer
Disease & Associated Disorders, 22(4), 375–381.
Davidson, B., Worrall, L., & Hickson, L. (2003). Identify-
ing the communication activities of older people with
aphasia: Evidence from naturalistic observation.
Aphasiology, 17(3), 243–264.
Donovan, N. J., Rosenbek, J. C., Ketterson, T. U., &
Velozo, C. A. (2006). Adding meaning to measure-
ment: Initial Rasch analysis of the ASHA FACS social
communication subtest. Aphasiology, 20(2–4),
362–373.
Frattali, C. M., Thompson, C. K., Holland, A. L., Wohl, C.
B., & Ferketic, M. M. (1995). American Speech-Lan-
guage-Hearing Association Functional Assessment of
Communication Skills for adults (ASHA FACS). Rock-
ville: ASHA.
Frattali, C. M., Thompson, C. K., Holland, A. L., Wohl, C.
B., Wenck, C. J., Slater, S. C., & Paul, D. (2017).
American Speech-Language-Hearing Association
Functional Assessment of Communication Skills for
adults (ASHA FACS). Rockville: ASHA.
Kagan, A., Simmons-Mackie, N., Rowland, A.,
Huijbregts, M., Shumway, E., McEwen, S., Threats,
T., & Sharp, S. (2008). Counting what counts: A frame-
work for capturing real-life outcomes of aphasia inter-
vention. Aphasiology, 22(3), 258–280.
Kertesz, A. (1982). Western aphasia battery. New York:
Grune & Stratton.
Lomas, J., Pickard, L., Bester, S., Elbard, H., Finlayson,
A., & Zoghaib, C. (1989). The communicative effec-
tiveness index: Development and psychometric
5
evaluation of a functional communication measure for
adults. Journal of Speech and Hearing Disorders, 54,
113–124.
Paul, D., Frattali, C. M., Holland, A. L., Thompson, C. K.,
& Slater, S. C. (2004a). American Speech-Language-
Hearing Association Functional Assessment of Com-
munication Skills for adults: Addendum. Rockville:
ASHA.
Paul, D., Frattali, C. M., Holland, A. L., Thompson, C. K.,
Caperton, C. J., & Slater, S. C. (2004b). Quality of
communication life scale. Rockville: ASHA.
Ross, K. B., & Wertz, R. T. (2002). Relationships between
language-based disability and quality of life in chroni-
cally aphasic adults. Aphasiology, 16(8), 791–800.
State University of New York at Buffalo Research Foun-
dation. (1993). Guide for use of the uniform data set for
medical rehabilitation: Functional Independence Mea-
sure. Buffalo: Author.
Turkstra, L. S., Coelho, C., & Ylvisaker, M. (2005). The
use of standardized tests for individuals with cognitive-
communication disorders. Seminars in Speech and
Language, 26(4), 215–222.
World Health Organization. (2001). International classifi-
cation of functioning, disability and health. Geneva:
Author.
Worrall, L., & Yiu, E. (2000). Effectiveness of functional
communication therapy by volunteers for people with
aphasia following stroke. Aphasiology, 14(9), 911–924.
Readings
American Speech-Language-Hearing Association. (n.d.).
National outcomes measurement system (NOMS).
Available from www.asha.org/NOMS
Davidson, B., & Worrall, L. (2000). The assessment of
activity limitation in functional communication: Chal-
lenges and choices. In L. E. Worrall & C. M. Frattali
(Eds.), Neurogenic communication disorders: A func-
tional approach (pp. 19–34). New York: Thieme.
Golper, L. C., & Frattali, C. M. (2012). Outcomes in
speech-language pathology: Contemporary theories,
models, and practices (2nd ed.). New York: Thieme.
Worrall, L., McCooey, R., Davidson, B., Larkins, B., &
Hickson, L. (2002). The validity of functional assess-
ments of communication and the activity/participation
components of the ICIDH-2: Do they reflect what really
happens in real-life? Journal of Communication Disor-
ders, 35(2), 107–137.